Salt-reduction strategies may compromise salt iodization programs: Learnings from South Africa and Ghana
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Nutrition
Abstract
Objectives: Universal salt iodization has been adopted by many countries to address iodine deficiency. More
recently, salt-reduction strategies have been widely implemented to meet global salt intake targets of
<5 g/d. Compatibility of the two policies has yet to be demonstrated. This study compares urinary iodine
excretion (UIE) according to 24-h urinary sodium excretion, between South Africa (SA) and Ghana; both
countries have implemented universal salt iodization, but in Ghana no salt-reduction legislation has been
implemented.
Methods: Participants from the World Health Organization’s Study on Global Ageing and Adult Health Wave
3, with survey and valid 24-h urinary data (Ghana, n = 495; SA, n = 707), comprised the sample. Median 24-h
UIE was compared across salt intake categories of <5, 5 9 and >9 g/d.
Results: In Ghana, median sodium excretion indicated a salt intake of 10.7 g/d (interquartile range
[IQR] = 7.6), and median UIE was 182.4 mg/L (IQR = 162.5). In SA, both values were lower: median
salt = 5.6 g/d (IQR = 5.0), median UIE = 100.2 mg/L (IQR = 129.6). UIE differed significantly across salt intake
categories (P < 0.001) in both countries, with positive correlations observed in both—Ghana: r = 0.1501, P <
0.0011; South Africa: r = 0.4050, P < 0.0001. Participants with salt intakes <9 g/d in SA did not meet the
World Health Organization’s recommended iodine intake of 150 mg/d, but this was not the case in Ghana.
Conclusions: Monitoring and surveillance of iodine status is recommended in countries that have introduced
salt-reduction strategies, in order to prevent reemergence of iodine deficiency.
Description
Research Article
Keywords
Iodized salt, Salt intake, Legislation, Sodium, Ghana, South Africa